I have been
experiencing a lot of acid reflux of late. I think it might have something
to do with the fact that I've been smoking more lately. Is this true?

There are many reasons to not smoke, and one of the reasons is that it can
definitely cause or worsen symptoms of esophageal reflux disease. First
off, tobacco inhibits saliva, which is a significant buffer that the body
has against acid. Secondly, studies have shown that tobacco can stimulate
the production of stomach acid production. Lastly, and most significantly,
tobacco causes a relaxation of the lower esophageal sphincter muscle,
thereby allowing acid reflux from the stomach to the esophagus to occur.

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I wake up
every morning coughing. I have been to my internal medicine doctor, an ear
nose and throat doctor and pulmonologist and have not gotten better. A
friend told me that they had a cough that was related to reflux. How can I
tell if that is the cause of my cough?

Chronic cough, sore throat, laryngitis with hoarseness and frequent
throat clearing can be due to acid reflux. There are a few mechanisms for
how this occurs. First off, acid that refluxes up the esophagus can
irritate the back of the throat, causing a sore throat, hoarsenesss and
cough. Secondly, as the acid comes up the esophagus, as the esophagus lies
next to the trachea, there can be irritation of the nerves and muscles of
the esophagus that can react with the nerves and muscles of the trachea,
making them hyperactive and causing a cough. Finally, small amounts of
regurgitated acid can get to the back of the mouth, and fall into the
trachea, irritate the bronchi and lungs equivalent to a micro-aspiration.
Frequently, treatment with medications used to treat acid reflux will
help. At times however, patients need to be treated with twice the dose of
such medications and frequently for at least 2-3 months before symptomatic
improvement is noted. You should check with your doctor as to whether
further investigation to the etiology of your cough with a
gastroenterologist is warranted.

I have been to the emergency room 3 times in the past month with chest
pain. Each time I am admitted because of the fear that it is my heart. My
internist says that it is not acid reflux as I had a normal endoscopy in the
past year, but I am suspicious that it might be as antacids seem to help. What
can I do?

First of all, you need to make sure that you are adhering
strictly to all of the lifestyle modifications of gastroesophageal reflux
disease. You need to lose weight if necessary, not smoke, not drink and not eat
foods that typically cause acid reflux such as caffeine, chocolate and
peppermints. You need to not eat late at night, and not lie flat within three
hours after eating. You should check with your doctor about staying on a
medication that lowers acid for at least a few months to see if the symptoms
abate. If all fails, you need to be referred back to your gastroenterologist.
It is not unusual for someone to have symptoms of acid reflux and have a normal
endoscopy. He may want to do other tests, such as a pH study of your esophagus
to rule out gastroesophageal reflux, or an esophageal manometery to look for
other esophageal causes of chest pain such as esophageal dysmotility,
esophageal spasm or achalasia. Finally, other non-cardiac or non-esophageal
causes of chest pain need to be considered as well. It can be very scary having
chest pain, as people usually think that it is coming from the heart. Check
with your doctor about what the next step in your evaluation should be.